Thursday, March 22, 2012

अनौठो मनोरोग: कन्भर्सन डिसअर्डर/Conversion Disorder


माको विवाह भएको १ वर्ष भयो। उनी २५ वर्षे युवती हुन्। श्रीमान साउदी अरवमा काम गर्न गएका ६ महिना जति भयो, उनी अहिले आफ्नो नन्द, देवर, सासूससूरासँग बस्छिन्। श्रीमानसँग फोनमा कुरा भइरहन्छ। गत १ महिनादेखि उनीमा एउटा नौलो समस्या देखिएको छ। उनी त्यतिबेला घरमै थिइन्, उनी एक्कासी काम्न थालिन् र बोल्न थालिन् "हेर, म देवी हुँ, तँलाई मार्छु, तँलाई खान्छु, मलाई पूजा गर, बलि चढा नत्र म तेरो सन्तानलाई नाश गरिदिन्छु" आदी इत्यादी। जुन करिब एक घण्टासम्म रह्यो, सारा मानिसहरु जम्मा भए, सबै छक्क परे। एक घण्टापछि उनी जस्ताको तस्तै भइन। कति मानिसले उनलाई 'बोक्सी' भने, कतिले 'देवताको रुप' भने, कसैले 'देवताको पूजा गरी बलि दिएमा निको हुन्छ' भने। तर उनको समस्या त्यसै निको भएकोले त्यो दिन केही गरिएन। तर भोलिपल्ट पर्सिपल्ट गर्दागर्दै पछि उनको समस्या दिनदिनै जस्तो देखिन थाल्यो। उनलाई धामीझाँक्री लगाइयो तर निको भएन। कुखुरा, बोका बलि दिइयो, त्यही पनि निको भएन। अहिले उनी अस्पतालमा मनोरोग विशेषज्ञसँग उपचार गराइरहेकी छिन्। उनको मनमा दविएका कुराहरु बाहिर निकाल्ने(pyschotherapy), साथै औषधीको प्रयोग गर्नाले उनको समस्या विस्तारै निको हुदैं गएको छ।

यस्तो रोगलाई कन्भर्सन डिसअर्डर(Conversion Disorder) भनिन्छ।

मनमा रहॆका आन्तरिक मानसिक पीडाहरु विभिन्न शारीरिक लक्षणका रुपमा बाहिर देखिने रोगलाई कन्भर्सन डिसअर्डर/Conversion Disorder भनिन्छ। हाम्रो समाजमा महिलाहरु खुल्लारुपमा आफ्नो समस्याहरु बताउन नसक्नु र पीडा सहेर बस्ने गर्नाले महिलाहरुमा यो रोग बढि देखिन्छ। त्यसो त पुरुषमा पनि यस्तो समस्या नदेखिने होइन। हाम्रो वर्षौंदेखिका तीतामिठा अनुभवहरु मस्तिष्कमा जम्मा भई बसेका हुन्छन्। कतिपय यस्ता समस्याहरु मनमा खुल्लारुपमा भने देखिदैनन् तर सपनामा वा अदृश्यरुपमा बोलीमा यी कुराहरु निस्कन्छन्। वास्तवमा यी बेहोसी मस्तिष्क/Subconscious mindमा रहेका पीडादायी कुराहरु बिरामीलाई बाहिरी रुपमा थाहा नहुन पनि सक्छ। त्यसैले अचानक यी पीडादायक कुराहरु एकाएक शारीरिक लक्षणका रुपमा देखिन थाल्छन्। जस्तै: अचानक बोली रोकिने, अचानक हातखुट्टा नचल्ने, काम्ने र देवता चढेको जस्तो बक्ने आदी।

यो रोग आफैंमा अनौठो मानिन्छ। किनभने बिरामीले केही समयको लागि अनौठो लक्षणहरु देखाउँछ र १-२ घण्टामा बिरामी जस्ताको तस्तै हुन्छ। जस्तै: कसैको अचानक खुट्टा नचल्ने (पारालाइसिस) भएर अस्पताल ल्याउनुपर्छ तर स्नायु प्रणालीको जाँच गर्दा, सबै अन्य जाँचहरु गर्दा, सिटी स्क्यान नै गरेर हेर्दा पनि उनमा केही खराबी देखिदैंन। तैपनि बिरामीले खुट्टा भने चलाउन सक्दैन। कोही अचानक बेहोस् हुने, काम्ने, फिज काड्ने पनि गर्ने गर्छन्। यसका लक्षणहरु अरु कसैको उपस्थितिमा मात्रै अर्थात् हेर्ने, देख्ने मान्छेहरु वरिपरि  भएको बेलामा मात्रै हुने गर्छ।

कतिपय यस्ता विरामीलाई बोक्सी लाग्यो भन्ने, कुखुरा, बोका बलि दिने चलन पनि छ, जुन ठिक होइन र एउटा अन्धविश्वास मात्र हो।

यो रोगका विरामीहरु कस्ताकस्ता लक्षणहरु लिइ अस्पताल आउँछन्?
यो रोग का लक्षणहरु विभिन्न थरिका हुनसक्छन।
विरामीले 'म अब फेन्ट हुनलागें भनेर अरुलाई बोलाउने र बेहोस हुने", उ बोल्न नसक्ने हुने तर अन्य जाँचहरु गर्दा सबै ठिक हुने। विरामी काम्ने, अर्कै मानिस, देवता जसरी बोल्ने, सिकिस्त विरामी जस्तै हुने, अहिले नै ज्यान जाला जस्तो गर्ने गर्छन्। फेरी केही समयपछि जस्ताको तस्तै हुने।
कोही विरामी अचानक आँखा नदेख्ने भएको बताउँछन्।
कोही विरामी हात वा खुट्टा नचल्ने, हिंड्न नसक्ने भएको बताउँछन्।
कोही विरामी शरीरको संवेदना थाहा पाउँदैनन्। जस्तै हातखुट्टामा छोएको थाहा नहुने।
कोही बोल्न सक्दैनन् र इशारामा कुरा गर्छन्।
कोही दमको रोगीको जस्तो छिटोछिटो श्वास फेर्छन्।
कोही विरामी केही समयका घटनाका बारेमा केही थाहा नभएको बताउँछन् अर्थात् स्मरण हराएको भन्छन्।
कोही विरामी अचानक अर्कै ठाँउमा पुग्छन् र त्यहाँ कसरी आएँ भन्नॆ कुनै जानकारी हुदैंन।
कोही विरामी भने उल्टो कुरा गर्ने गर्छन्। सोधिएको प्रश्नलाई बंगाएर उत्तर दिने सजिलो प्रश्नको उत्तर नदिने तर गाह्रो प्रश्नको उत्तर दिने झुटो बोलेको जस्तो गर्ने गर्छन्।

यो रोग किन हुन्छ?
मानसिक तनावहरु विभिन्न शारीरिक लक्षणहरुमा परिणत हुने/psychological stress converts to physical symptoms भएकोले यसलाई कन्भर्सन डिसअर्डर(Conversion Disorder) भनिएको हो। यो रोग मनमा धेरै कुरा राख्ने र मनको कुरा अरुलाई नभन्ने मानिसमा बढि पाइन्छ। प्रेशर कुकरमा हावा भरिएर चाप बढि भइ अचानक सिट्ठी बजेजस्तै मानिसमा हुने मानसिक तनावले पनि बाहिर निस्कने बाटोको रुपमा शारीरिक लक्षणहरु देखिन्छन्। बेहोसी मस्तिष्क/Subconscious mind वा भित्री मनमा रहेको अन्तरद्धन्द घटाउन गरिएको उपायको रुपमा यो रोगको लक्षणहरुलाई लिइन्छ। यो रोगले तत्कालीन तनावका साथै धेरै वर्ष अघिका तनावले पनि ल्याउनसक्छ।

पहिले यो रोगलाई हिस्टेरिया/Hysteria भनिन्थ्यो र यौनकुण्ठाका कारण यस्तो समस्या हुन्छ भनिन्थ्यो। तर यो कुनै पनि प्रकारका मानसिक तनावका कारण हुनसक्छ र महिलामा मात्र नभई पुरुषमा पनि यस्तो समस्या देखिनसक्छ। पुरै स्कुलका विध्यार्थीहरु अचानक बेहोस् हुन थालेको, देउता चढेको जस्तो बोल्न थालेको घटनाहरु बेला बेलामा समाचारमा सुन्न पाईन्छ, ती घटनाहरु यही रोगका कारण भएका हुनसक्छन। विकीपेडियाको यो लेख हेर्नुहोस्।

केही वर्ष अघि पुर्वी नेपालको एउटा स्कुलमा भएको 'मास हिस्टेरिया/Mass Hysteria' को बारेमा मनोरोग विशेषज्ञ डा. रवी शाक्यले लेख्नुभएको केस रिपोर्ट। यसबाट पनि यस्ता समस्या कसरी शुरु हुन्छ, कसरी फैलन्छ र कसरी उपचार गरिन्छ भनेर थाहा हुन्छ।

यहाँ बुझ्नु पर्ने कुरा के छ भने विरामीले जानीजानी यस्तो गरेका हुँदैनन, विरामीलाई किन यस्तो गरेको छु भन्ने थाहा नै हुँदैन। विरामीले नियन्त्रण गर्न खोज्दा पनि यस्तो लक्षण रोक्न सक्दैनन। बोक्सी लागेको हो भन्दै विरामीलाई कुट्ने, आगोले पोल्ने आदि अन्धविश्वासका कारण कति मानिसको अकालमा ज्यान गएको पनि पाइएको छ।

नेपालमा यो रोगका विरामी धेरै छन्। सामाजिक रितीरिवाज, धार्मिक विश्वास र संस्कृति अनुसार यो रोगका लक्षणहरु फरक पर्न सक्छन्। नेपालमा डिप्रेशन रोगका विरामी पनि यस्तै लक्षणहरु लिएर आउँछन् तर डिप्रेशनमा यी बाहेक अन्य लक्षणहरु पनि देखिन्छन्।

यो रोगको कसरी उपचार गरिन्छ?
यो रोगको उपचार निकै चुनौतीपूर्ण हुनेगर्छ। विरामीको लक्षणलाई ध्यान दिईरहँदा त्यो अझै बढ्न जान्छ। यो रोगका लक्षणहरु देखिएको बेलामा विरामीको वरिपरि बसी आत्तिएमा लक्षणहरु अझै बढ्न जान्छन्। त्यसैले विरामीलाई अन्य कुरा गरी दिमाग/सोचाइ अन्ततिर मोड्नुपर्छ। विरामीलाई मनका कुरा खुल्लारुपमा भन्न प्रोत्साहन गर्नुपर्छ। विरामीले रोगको सिकायत गर्छ, बढि हेरचाह खोज्छ/Attention seeking behavior भने त्यसलाई महत्व दिनु हुदैंन र निरुत्साहित गर्नुपर्छ। विरामीसँग सकेसम्म थोरै मानिस बस्नुपर्छ। विरामीलाई तत्काल अस्पताल लगी उपचार गराउनुपर्छ। यसरी विरामीको लक्षणलाई बेवास्ता गर्दा रोग निको हुन सहयोग गर्छ। साथै विभिन्न प्रकारका मानसिक अन्तरद्धन्द कम गर्ने औषधीहरुको पनि प्रयोग गर्ने गरिन्छ। साइकियाट्रिस्ट र साइकोलोजिस्टहरुसँग यो रोगको उपचार गराउनुपर्छ।


यो रोग बारे जान्नैपर्ने कुराहरु:
यस्ता विरामीलाई कहिलेकाहीं अचानक श्वास फेर्न गाह्रो हुने, कहिले पूरै निको हुने र कहिले अत्यधिक बढ्ने हुन्छ।
विरामीसँग धेरै मानिसको भीड गर्नुहुदैंन, विरामीको लक्षणलाई वास्ता गर्नुहुदैंन नत्र लक्षणहरु झन बढेर जान्छ।
कति विरामीहरुमा यो समस्या बारम्बार दोहोरिन सक्छ। तर नआत्तिकन लगातार उपचार गराइरह्यो भने २-३ हप्तामा यो समस्या विस्तारै निको हुन्छ।
कतिपय विरामीलाई भूत चढेको, भनी बोक्सी लागेको भनी कुटपीट गर्ने, सजाय दिने गरिन्छ, जुन शतप्रतिशत गलत हो।

-यो लेख मनोरोग विशेषज्ञ डा. सि. पि. सेढाईले लेख्नु भएको हो, जसलाई मैले थोरै परिमार्जन गरेको छु।

यो रोगको बारेमा यस भिडियोबाट पनि धेरै कुरा थाहा पाउन सकिन्छ।

यो पनि हेर्नुहोला:
के हो मास हिस्टेरिया?


32 comments:

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